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Saturday, November 13, 2010

Medicare Part D Rant

  OK, its that time of year. I'm not talking about open enrollment; I'm talking about the time of year when a larger majority of Medicare Part D recipients enter the dreaded "donut hole". I agree that its probably the most asinine way to manage this system and I really can't understand the concept, but its there and we have to deal with it. My biggest gripe about it is the people that act totally, completely surprised that there even is such a thing. Where have they been to not know about this? They act like the government is personally attacking them or, better yet, that the pharmacy is just trying to screw them. The majority of these recipients are over the age of 65 correct? Do they not remember the time before Medicare Part D when they had to pay full price for their meds every time? I mean, for God sake, I can remember when this plan started! Why can people not be grateful for what they have received instead of complaining about what they think they deserve? I guess I just don't get it. I really think that part of the problem is that they don't realise how much  their drugs normally would cost when they only have to pay $1.10 all year. Maybe we should start having our technicians point out to them how much their insurance saved them each time they check-out. Even my grocery store does that! Maybe it would make our patients a little more grateful. Not to mention the fact that they still get a discount even in the donut hole, its just not what they are used to. Every now and then I run into someone who gets it and is happy to hand over whatever money they have to because they either know how important the drug is to their health or they realise that things could be a lot worse for them without this insurance. Even when I point out to most patients that when they enter the donut hole they will get a $250 rebate check from Uncle Sam, they are still pissy with me. I had one lady say "If they are going to treat me this way then I guess I just won't take my medicine and die!" What is that about? Who are the mysterious they and how is dying going to teach them a lesson? I guess it just frustrates me because I do realise how much my insurance saves me. I personally use one medication that would cost me over $4000 per month if I didn't have insurance. And I take alot more than just one medication. Ingratitude annoys me. I can handle when people are not grateful for my services, that's just part of the job, but to not be grateful for a system that saves you hundreds or even thousands of dollars a month is crazy and more than a little selfcentered.
       On a more positive note I do encourage my patients to be, well...patient. The donut hole is going to close eventually. Also, this time of year, don't have them buy a 90 day supply when the plan year will start over at the first of the year. I also use this opportunity to teach them about their formulary and making sure they give a copy of it to their doctor. Let's face it, most drugs have a less expensive alternative. That's what formularies are all about. The docs are going to write for whatever drug they have samples for, and we all know that this translates into whatever drug is newer and more expensive. I mean really, do you have to give your patient Seroquel just because they don't sleep well?
   That brings me to another point. I would love to have a law passed that says the docs have to put on the rx what its being used for. Not only would it help us with proper counseling, it would help us to ascertain it there is a less expensive alternative that we could "lobby" the doc for. I think this may be a law in some states (California maybe?). With so many drugs being used off-label we often have a guessing game on our hands when counseling. How many of you have counseled a patient receiving Metformin that it is used to lower blood sugar, just to find out they are using it for poly-cystic ovarian disease?  I have a doc in town who is prescribing Victoza for weight loss!!  If the state boards think counseling is so important then how about making it easier for us to do it more effectively. How many times have you counseled someone on a med and they had no idea what they were taking it for? What did they go to the doc about anyway?
  Well, enough of my ranting. I do make a point of kindly pointing out how much a patient's insurance is saving them when they complain about prices. I personally  remember a time before rx insurance and I believe that the advent of insurance is what has driven prices so high. , but that's a subject for another post.

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